Medic26

Yes I am very proud of where I work and like most any other agency's we have a few bad apples just like everyone else. No need to explain that any further cause if you've been around long enough you know what I mean. As far as progressive protocols and the like, we are stuck with what the state gives us (PA) and they aren't too bad at all. We were one of the first services in the area with 12-lead, Wave form capnography, CPAP and are always looking for new things to bring our patients. By no means are we cutting edge but always looking to improve.....from care to equipment. www.gvems.org

I know alot of places with a 12-lead usually set up the 3 standard monitored leads on the screen as II, III, AVF. Not sure if this is what they wanted to accomplish with a 5 lead cable as the 3 lead would not be able to do this. :?: You could also monitor V-1 if they were set up correctly with the 5 leads like an ICU type/critical care monitor, interesting?

http://www.dsf.health.state.pa.us/health/l...tocols_2004.pdf page 54 Its still listed here but with several considerations. I can't tell you the last time I actually saw it used though.

No Places that do it should maintain strict protocols/QI procedures and have to be credentialed for the procedure.

I think this exactlty why RSI has been abused in the prehospital setting. Medics are so afraid of a little bit of blood in the nasal passage to attempt Nasal tubes. Since CPAP has been introduced our nasal tubes have declined in frequency but I still consider it on any patient that I want to secure an airway on, and they are actually fairly simple.

Yes, Thank you for this unique case.

No places that I have worked have a policy in place for this type of situation. I suppose that if the patient is requesting someone else than they are not sick enough to be calling in the first place, for MOST situations. We have several frequent flyers that have refused once we showed up they saw who was working or we wouldn't take them to a hospital 20 miles away when we can see the local facility from the scene.

Has he been doing any traveling or been laying around in bed alot?

Now Dust, your an educated person. Wouldn't you rather think that change would more likely come from a gradual approach, slowly increasing the standards until they reach your expected level? Yes its time consuming but the end result would be the same.

Rid stated - "What is a shame most medics really do NOT care about patient care!" If this were true many of them would not be practicing today. I think the shame is that we cannot agree we all have different views. Excuse me for the next 48 hours as I will be participating in a conference to further my knowledge. I will resume my banter with you after I am done.

Paramedics beating their chest....refer to the two posts above. :roll: It sounds like you are talking down about BLS providers, not being good enough. Maybe this is not your intention. So to boil it all down you guys would rather the "entry level" EMS position to be a paramedic? You have assumed that I am against this theory........it would be great but its just not feasible. Nobody has disputed that fact that a dual medic unit would be able to provide the best care. Rid stated - "Other medical professions have not diluted their programs and instituted alternate levels to provide lower care!" If this is true, there would only be "nurses". But the case is there are RN's, LPN's, NP's, Etc. and to break it down further RN's can obtain a certificate, associates, bachelor or masters degree. Which part of this training do you regard as the "gold standard"?

By this I mean that they think everyone should be a paramedic....because thats what they are. Some get that "P" after the "EMT" and forget where they came from, that most of them too started as a basic and earned there keep just like most everyone else. Learning how to be a good EMT and doing basic skills before advancing to the ALS level. Building upon a basic working knowledge of how things need to be done before they are in charge and taking in an overwhelming responsability. Do you really think that the person driving the ambulance and lifting the wheels on the stretcher should be a paramedic? Its just not feasible for the whole system, many places have a multi-teared system and it works well, other places not so well. Do you really think from a financial standpoint as a executive director of a large EMS organization you could afford to pay people who spend several years obtaining a degree to run dual medic trucks in rural america where call volumes are only 100 calls per year? Now, while I do think that "basics" have their place in the 911 system I do realize that there is a need for elevated education across the board. For example, an EMT would be given a more thorough understanding of why they are doing something instead of the standard........because the protocol says too!!

I never siad anything about keeping anyone happy. You could be right about the stronger paramedic being a teacher and bringing the lesser provider along, however you are assuming that they will all teach and be patient, explaining things along the way. Where I come from, our system has a few "paramedic" EMT's who couldn't cut the grade and now they are paid and operate at the EMT level. Yes they were given many chances to get help, remedy their profound weakness's and they have had to face the fact that not everyone is cut out to do the job.

I work in both types of systems, personally I could care less either way. The dual medic system is nice when you have a critical patient because things usually go better and get done without asking. This is not always true and I have had many EMT partners that I work well with in the same way. In my own personal opinion dual medic trucks allow for weaker providers because a poor medic has someone to lean on all the time, someone else to perform their skills for them if needed and someone to help assess the patient if they are clueless.......but this can be good too in extreme cases. I feel that EMT's who work on ALS trucks with a paramedic partner make better paramedics and do much better. This is only from my personel experience and could be different in other systems. My personel opinion is that some of the "paramedics" that favor only dual medic trucks running 911 are only beating their chest like baffoons to stroke thier own ego's. Every system is different and no one solution will work for everybody.

Exactly

None unless they have a court order.

I know what you meant, I agreed with your question but sounds like it didn't get done.

Basic ACLS, re-confirm after each time the patient is moved. In my mind if there is even the slightest bit of doubt the patient gets extubated and re-intubated.

I am slightly anal when it comes to the limb leads getting all knotted together, so at the start of my shift I pre-attach a strip of 4 electrodes to the leads and pre-attach the precordial leads to electodes too. Of course we carry our electrodes in strips of 4 so they stay put. We have Zoll and I have seen those clips laying around but never failed when we used them that someone will take them off or lose them.

I can realisticly say that less than 1% of my patient transports are emergency mode, even cardiac arrest patients since we are doing the very same treatments the ER will be doing. MI's, no lights on them either unless they become "unstable". CVA is no L & S per protocol unless the patient is crowding the 3 hour window and that 2 minutes you save might help. We did a "time study" at my full time service about 5 years ago, involving distance traveled measured in miles and response time between the two modes. Time saved was less than 1 minute on our average response time of around 8 minutes. So you can see where the risk of crashing is not worth the gain. Furthermore, I have seen very few providers who have been "trained" enough to drive properly in emergency mode......even ones with 10+ years on the job. One of my part time services uses L & S all the time on transporting patients........way overkill and saves minimal time but these guys have done it for years and you can't change "the old way".

Major Bummer, never thought about the K as a bolus

When we first started to use CPAP here about 4 years ago, the first patient in our region to get CPAP was a COPD patient......this happened by mistake and that provider no longer works here but it has worked a few times for us since we started using it on severe distress patients who show no improvements with standard treatments.

Did the patient have a fever, how long had she been producing yellow sputum and has she ever had pneumonia in the past? From the sounds of it, this patient is probobly mildly short of breath all the time and has learned to live with it. Sometimes they are just too far gone for you to see any drastic improvements in what short time we spend with them.

The patient was given phenergan?

Potasssium is low so a k-run is in order, other than that I am stumped. Work down the H's and T's till we rule everything out.